Anthem and Epic are joining forces to enable two-way data sharing with providers. Their aim is to enhance clinical decision support and administrative processes like prior authorizations.
Per the collaboration, announced Wednesday, Epic’s Payer Platform will be integrated with Anthem’s Health OS, which is the payer’s operating system. This will enable the secure and bi-directional exchange of different types of data, including clinical information and admissions, discharge and transfer data.
“Anthem will be able to capture consumer health information provided by clinicians, analyze that data and develop data-driven insights,” said Ashok Chennuru, the company’s chief data and insights officer, in an email. “These insights can then be delivered back to the provider/care team — in near real-time — to flag potential care needs and inform treatment decisions, resulting in higher quality care.”
For example, the integration will allow for clinical document exchange, enabling providers to send payer-specific consolidated clinical document architecture (CCDAs) to inform risk adjustment and close care gaps, Chennuru said.
Not only that but providers will also be notified of significant patient health events, like getting discharged from the hospital so they can provide timely follow-up care.
“This [data exchange] effort helps bring the industry into the next step of its evolution where the right information gets to the right people at the right time,” Chennuru said.
Further, the effort will streamline the prior authorization process, enabling providers to send prior authorization requests through Epic — instead of having to use the phone or fax — and receive a response electronically.
Improving the prior authorization process is a key focus for payers, and Anthem is not the first insurer Epic is collaborating with to achieve this goal. In March, Epic and Humana announced that their partnership has entered a new phase focusing on enhancing prior authorization requests and responses.
Initially, only a handful of providers will participate in the Anthem-Epic data-sharing effort, including MetroHealth System in Cleveland.
“Being able to better communicate and reduce the amount of time we need to spend on administrative processes will allow our clinicians to spend more time delivering care,” said Dr. David Kaelber, chief medical informatics officer at MetroHealth, in a news release obtained by MedCity News.
The number of participating providers is anticipated to grow as the collaboration continues, Chennuru said.
Photo: Dmitrii_Guzhanin, Getty Images
